Therapeutic approaches to patients with pilonidal sinus based on specific clinical characteristics

Controversies exist about the optimal treatment for patients with pilonidal disease. Our therapeutic approach to patients with this condition has been conservative treatment. Surgery was performed only after failure of conservative treatment. Surgery consisted of excision of the sinus and primary closure in patients of female sex and with sinus of small dimensions. Excision and Limberg flap was performed in male patients with a large sinus. Conservative treatment was successful in almost 50% of the patients. Excision and Limberg flap reconstruction had fewer recurrences than excision and primary closure; however, patients were less satisfied from an aesthetic point of view. Therapeutic approach to patients with pilonidal sinus should be modified according to the clinical conditions of the patient and anatomic characteristics of sinus.